Urgent Contrast-Enhanced Computed Tomography before Early Colonoscopy in the Management of Colonic Diverticular...

Area of Science:

• Gastroenterology
• Radiology
• Clinical Trials

Background:

• Contrast-enhanced computed tomography (CE-CT) is increasingly used for colonic diverticular bleeding (CDB).
• Its role beyond diagnosis in improving clinical outcomes remains unclear.
• This study investigates the impact of urgent CE-CT on CDB management.

Purpose of the Study:

• To determine if urgent CE-CT improves stigmata of recent hemorrhage (SRH) identification during early colonoscopy (≤24h).
• To assess the effect of urgent CE-CT on other clinical outcomes in CDB patients.

Main Methods:

• A randomized, open-label, controlled trial involving 23 Japanese institutions.
• 240 hemodynamically stable patients with suspected CDB were randomized.
• Groups: urgent CE-CT followed by early colonoscopy vs. early colonoscopy alone.

Main Results:

• No significant difference in SRH identification between groups (20.0% vs. 17.8%, p=0.739).
• Successful endoscopic hemostasis rates were similar (18.3% vs. 17.8%, p=1.000).
• No significant differences in rebleeding, hospital stay, or transfusion needs were observed.

Conclusions:

• Urgent CE-CT before early colonoscopy does not enhance SRH detection or clinical outcomes in stable CDB patients.
• Routine use of urgent CE-CT is not recommended for this patient group.
• Low rate of contrast extravasation on CE-CT supports this conclusion.